Women's Health Care in Guatemala

Pueblo Partisans, through partnerships with North American Schools of Nursing, has provided Women’s health clinics in Guatemala since 1995.

The Problem of Cervical Cancer

Women of Guatemala who are poor, whether of indigenous or European decent, lack access to preventative health care. Cervical cancer is the leading cause of cancer among Guatemalan women 1, indicating that these women are also at risk for all other sexually transmitted infections.

In Guatemala, cervical cancer is the leading cause of cancer and the second leading cause of death, to cancer, among women. It is estimated that fewer than 10% of women receive annual Pap smears. Barriers to Pap smears include limited patient financial resources, lack of trained personnel and an inadequate emphasis on women's health. Source: Mathers, Wigton and Leonhardt (2005)

The roots of risk are found in the social turmoil and economic instability born of years of civil war. Added to this are the entrenched economic inequality and racism experienced by the poor who are undereducated, female and of indigenous status. This contributes to the epidemiology of cervical cancer and other sexually transmitted infections.

Pueblo Partisans has emphasised women’s health since 1995, when delegations of nursing students began to offer free or nominally priced Pap smear tests to women in the Comitancillo region of Guatemala's Western Highlands.

While indigenous women have not traditionally had the means to negotiate condom use with their partners, they have desired screening for cervical cancer. Women they knew were dying in their midst. Pueblo Partisans, working with local midwives, supportive physicians, labs and local partner organizations, has provided over one hundred Pap tests each spring. Clinics are held in remote, largely Mayan, locales. Treatment or referral services are provided, as needed.

Systemic gender inequality, and a lack of access to family planning opportunities, contribute to a Guatemala's fertility rate of 4.6 births per woman. This is the highest rate in the Americas. Source: 2007/2008 UN Human Development Report

Working with delegations of nursing students and in conjunction with women’s health clinics, Pueblo Partisans also provides adult and child health screenings, generally under primitive conditions. Such clinics are community requested and community supported endeavours. They serve as a way to identify and empirically treat or refer many conditions. These conditions may cause chronic ill health or, in the case of cervical cancer and in the absence of medical assistance, slow death.

Learning Experiences

North American students learn a number of key lessons from such clinics.

·     Students first learn about respect for the women and for their feelings regarding their body and the gynecological exam.

·     Students learn about cultural differences and the need to effectively connect with women during such exams. They learn to be attuned to cultural cues and to be aware of how cultural differences may lead to miscommunication. To this end, much work is conducted with the assistance of a culturally competent interpreter, who is generally a community leader and lay health worker. This person engages in an ongoing dialogue with students and instructors and also offers some language training.

·     Students learn to allow the focus to be on the women participating in exams and to acknowledge the entirety of their life experience. Many have a history of domestic violence and partner alcohol abuse. They may also have culturally bound somatic and mental illnesses stemming from the experience of war and violence. This condition has a clinical presentation similar to Post Traumatic Stress Disorder.

·     Lastly, students learn to provide professional, safe and (generally) pain-free Pap test screening, with the objective of identifying gross abnormalities that require further follow-up care.

In Guatemala, only 41% of births are attended by skilled health personnel. In the Americas, only Haiti has a lower rate. Source: 2007/2008 UN Human Development Report

Gaining Competencies

Student nurses develop clinical and personal competencies by listening to the women, addressing their concerns and encouraging resource identification. By doing so, the clients of the clinic may begin to appreciate their worth and become cognizant of options. These are essential building blocks for women who carry great family responsibility and have often been marginalized.

Pueblo Partisans welcomes donations earmarked for lab work, medical referrals and follow-up care for women’s health, as well as for adult and pediatric referrals for its annual health care delegations.

Mathers, L.J. MD. T.R. Wigton MD, and J.G. Leonhardt MD. 2005. Screening for cervical neoplasia in an unselected rural Guatemalan population using direct visual inspection after acetic acid application: a pilot study. Journal of Lower Genital Tract Disease 9(4): 232-235. (Abstract of the article)

Chris Nelson is a Women’s Health Care Nurse Practitioner in Chico, California. She has offered her services as a nursing student preceptor, and as a Pueblo Partisans volunteer, since 1995.